Welcome back everyone.
Nursing care has certainly progressed
since the days of Florence Nightingale.
In fact, Florence Nightingale herself was a pioneer
in the beginning stages of the advancements
of infection control and healthcare by using
one important skill - critical thinking.
In nursing, critical thinking for clinical-decision making
is the ability to think in a systematic and logical manner
with openness to question and
reflect on the reasoning process
used to ensure safe nursing
practice and quality care.
Critical thinking is more complex than the
everyday thoughts that fill our heads.
Critical thinking implies an active
application of analysis to thought processes.
Now, there are a number of standards related to critical
thinking and questions people may pose to themselves
to aid in the critical
Clarity is simply the ability to think clearly and
logically and to express and understand an idea
in more than one medium such as in
the spoken or the written word.
For example, if new guidelines are
being developed, the steps involved
and the supporting evidence
should be clearly outlined.
In seeking clarity, one might ask
for more information or examples.
Accuracy is carrying out tasks and treatments
correctly, obtaining evidence from appropriate sources
and evaluating the
For example, hospital policy may require marking
a surgical site in advance with permanent ink
to ensure the surgery is
conducted on the proper site.
In seeking accuracy, one might ask
how to verify or test information.
Precision is taking the time
to follow steps exactly.
If for example, the nurse fails to check insulin dose
with the second nurse, an error may go unnoticed.
Lack of precision often occurs as a result
of healthcare personnel being rushed
or attempting to take
shortcuts in procedures.
In seeking precision, one might
ask for more specific details.
Achieving relevance means sorting through
all of the available information and data
and determine which is relevant
to the situation at hand.
For example, when assessing a
patient with a stabbed wound,
the fact that that the patient
is homeless is not relevant.
This does not mean that the
homeless condition is irrelevant,
it may be very relevant to the
police or to his general health
but it's simply not relevant
to this particular assessment.
In seeking relevance, one may ask how this
information relates to the problem at hand.
Depth - sometimes what
people do is superficial.
Dealing with the problem at hand
without looking deeper at the cause.
But healthcare providers must always try to look at the
complexity of a situation to determine root causes.
For example, if an adolescent is repeatedly
hospitalized for failing to take asthma medications,
stabilizing the teen and sending her home without trying
to determine the underlying reason for her failure
to take medications does
little to solve the problem.
In seeking depth, one might ask what
factors are involved in this problem
and what is the best way to seek solutions?
Situations may be very complicated in medical care,
so one should look at the breadth of a situation
from numerous perspectives rather than
just looking from one perspective only.
For example, a person dying of cancer
may want a "Do Not Rescucitate" order
while the spouse or the children
may be adamantly opposed.
Now, while an adult patient has the right to make
this decision, family dynamics usually require
that the feelings of other
members also be considered.
Now, the healthcare provider may be in the position to
provide support and really help people arrive at a decision.
In seeking breadth, one might ask if other perspectives
should be considered or perhaps even alternative actions.
Logic is simply the application of
reason and following of logical steps.
For example, the nursing process is followed in a logical
progression from assessment to diagnosing the problem
to planning an intervention to implementing the
plan and then finally, to evaluating the results.
Conclusions are arrived at
by reviewing the evidence.
In seeking logic, one may ask if something
makes sense or if it seems logical.
Some information or actions are more
critical or significant than others.
The healthcare provider must be able to exercise reasonable
judgement about the significance of the information.
For example, if a patient receiving a transfusion
suddenly shows signs of anaphylaxis,
stopping the transfusion immediately
is far more significant
than reporting the
reaction to the physician.
Issues related to significance
are very common in nursing.
In seeking significance, one might ask what the
most important problem or central issue is.
Fairness is being open to new ideas and willing
to consider new or different approaches.
Many of the problems in healthcare derive
from the unwillingness to make changes.
People become really familiar
with procedures or processes
and they don't want to learn new ways of
doing things, even if they're better.
For example, a switch to computerized charting
will decrease the incidence of medication errors
but it's going to require the healthcare
personnel to learn to use the new system
and to learn new ways
to chart information.
Now, while this change would impose a burden to
the staff, applying the principles of fairness
meant that the benefits to the patients
outweigh the inconvenience to the staff.
In seeking fairness, one might ask if selfishnes or
personal views are interferring with fairness to others.
Decision making and development of guidelines
often begin with the review of the literature.
Healthcare providers must read critically
using care to evaluate the evidence
while keeping an open mind
to other possibilities.
The first step in the critical reading is
to consider the source of the material.
Juried medical journals or peer-reviewed nursing journals
are always a more valid source than the popular press.
Now while this is not a guarantee
that the information is correct,
having the material reviewed by a number of different
people really helps ensure that the most journal or articles
are based on solid research and
that the reasoning is sound.
Next, you're gonna review
the author's credentials.
Ask yourself these questions,
Who is the author
or the authors?
Is it a reporter? A nurse?
A doctor? A researcher?
Once you always review the author's credentials to determine
if the person is an expert in the field of study.
Determine the central thesis.
The thesis or central claim of research
should be clearly stated in the introduction.
One way to quickly evaluate
an article or book
is to read the introduction and the
conclusion before the body of the text.
The conclusion usually provides the summary
of the thesis and the main supporting points.
This is also a quick and
efficient way to determine
whether the material is worth reading for the
purpose of study or it should be eliminated.
Examine the organization
The methodology used to research or reach
conclusion should be clearly outlined.
If the article or book is based on a
particular theory, this should also be stated.
The organization of the article itself should also be reviewed
to determine if it corresponds with the usual practice.
Ask yourself these question:
Does it have a clear introduction?
Is it organized in a logical manner?
Is there a concluding summary?
Is the language and terminology
appropriate for the intended reader?
And next, review the evidence.
Evidence is critical.
The evidence provided should always
support the main points of the article.
And finally, evaluate.
The overall article should be evaluated to determine
if the content seems credible and useful.
During evaluation, all the other steps in the critical
review of the literature should be considered
in determining if the article
is sufficiently valid.
So remember, critical thinking includes adherence to
intellectual standards, proficiency in using reasoning,
a commitment to develop and maintain intellectual
traits of the mind and habits of thought
and the competent use of thinking skills and abilities
for sound clinical judgements and safe decision making.
So, in thinking of what we've learned today,
I'd like you to consider this question.
When conducting a review of the literature,
what are the most important steps to follow?
You're going to consider the source,
you're going to review the
determine the central thesis,
examine the organization and
methodology of the study,
review the evidence,
and then fully evaluate the article
to see if it makes sense for you.
I hope you've enjoyed today's
video on critical thinking.
Thanks so much for watching.